Korean Circ J. 2008 Mar;38(3):161-169. Korean.
Published online Mar 31, 2008.
Copyright © 2008 The Korean Society of Cardiology
Original Article

Predictive Factors of Major Adverse Cardiac Events and Clinical Outcomes of Acute Myocardial Infarction in Young Korean Patients

Jae Yeong Cho, MD, Myung Ho Jeong, MD, Youngkeun Ahn, MD, Shung Chull Chae, MD, In Hwan Seong, MD, Young Jo Kim, MD, Junghan Yoon, MD, Jay Young Rhew, MD, Jei Keon Chae, MD, In Ho Chae, MD, Nae Hee Lee, MD, Jin Yong Hwang, MD, Myeong Chan Cho, MD, Kee Sik Kim, MD, Chong Jin Kim, MD, Wook Sung Chung, MD, Seung Woon Rha, MD, Yang Soo Jang, MD, Ki Bae Seung, MD, Seung Jung Park, MD and Other Korea Acute Myocardial Infarction Registry Investigators
    • Korea Acute Myocardial Infarction Registry of the Korean Society of Cardiology, Gwangju, Korea.
Received October 18, 2007; Accepted December 03, 2007.

Abstract

Background and Objectives

Acute myocardial infarction (AMI) occurring in patients at a young age (40 years or younger) is an uncommon condition and is characterized by multiple cardiovascular risk factors. We analyzed the risk factors of young-aged Korean AMI patients (age of 40 years or younger) and other AMI patients, who were registered in the Korea Acute Myocardial Infarction Registry (KAMIR) for one year.

Subjects and Methods

In 2006, 8,565 patients (mean age 64.4±12.7 years; 5,591 males) were registered in the KAMIR. The patients were divided into two groups: Group I (younger patients ≤40 years; n=261; mean age 35.9±4.5 years; 245 males) and Group II (older patients >40 years; n=8,304, mean age 65.4±11.8 years; 5,330 males). The clinical and angiographic characteristics and major adverse cardiac events (MACE) were compared for the two groups of patients.

Results

The baseline clinical characteristics of gender, age, risk factors (hypertension, smoking, diabetes, familial history) and body weight were different between the two groups (p<0.001). The baseline echocardiographic and laboratory findings of the initial ejection fraction, and the glomerular filtration rate, level of creatine kinase (CK), level of CK-MB isoenzyme, total cholesterol level, triglyceride level, and N-terminal prohormone brain natriuretic peptide (NT-proBNP) level were different between the two groups (p≤0.001). According to the use of multiple logistic regression analysis, use of thrombolysis [p=0.009, adjusted hazard ratio (aHR)=9.140, 95% confidence interval (CI): 1.727-48.383], a high blood glucose level (p=0.029, aHR=1.008, 95% CI: 1.001-1.016), a low body mass index (<25 kg/m2, p=0.031, aHR=6.236, 95% CI: 1.183-32.857), and a high CK-MB level and high Thrombolysis in Myocardial Infarction (TIMI) risk score were independent predictors of MACE at 1 year after an AMI in young age patients. Early clinical outcomes were better in Group I than in Group II patients, but one-, six-and twelve-month MACE were not different between the two groups.

Conclusion

The independent predictors of MACE at 1 year in young age AMI patients were the use of thrombolysis, a high blood glucose level, a low body mass index, a high CK-MB level and a high TIMI risk score. Patients that have had an acute myocardial infarction at a young age have a better early clinical outcome, but the long-term clinical outcomes were not different compared with older patients, and thus long-term intensive medical therapy will be required, even in young AMI patients.

Keywords
Myocardial infarction; Age of onset; Prognosis

Figures

Fig. 1
MACE-free survival during one-year follow-up. It was not different between the young and old aged patients [age≤40 (Group I) and age >40 (Group II)] (p<0.136 by the log-rank test). MACE: major adverse cardiac events.

Tables

Table 1
Baseline clinical characteristics

Table 2
Comparison of initial laboratory findings

Table 3
Comparison of previous and post-myocardial infarction medications between two groups

Table 4
Comparison of ECG presentations between two groups

Table 5
Independent predictors of major adverse cardiac events at one-year follow-up in the young age acute myocardial infarction

Table 6
Comparison of coronary angiographic findings

Table 7
Comparison of early clinical outcomes and MACE

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